Provider Demographics
NPI:1790135358
Name:GAZZARA, JEFFREY ANTHONY JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ANTHONY
Last Name:GAZZARA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-1121
Mailing Address - Country:US
Mailing Address - Phone:856-236-0155
Mailing Address - Fax:
Practice Address - Street 1:621, 1515 MARKET STREET
Practice Address - Street 2:SUITE 1200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1921
Practice Address - Country:US
Practice Address - Phone:856-236-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302466208D00000X
CODR.0063013208D00000X
MO2020003560208D00000X
ALSP.243208D00000X
VT032.0133783208D00000X
MEDO2764208D00000X
WVITRDO-008208D00000X
MI5101022520208D00000X
FLOS15642208D00000X
GA847321208D00000X
PAOS018948208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice